P110: Outcome of high-dose chemotherapy (HDCT) and autologous stem cell transplant (ASCT) as first salvage treatment for relapsed or refractory classical Hodgkin Lymphoma (cHL) in the era of PET-adapted strategy among Italian centers
Authors: Simonetta Viviani, Anna Vanazzi, Samuele Frassoni, Chiara Rusconi, Andrea Rossi, Alessandra Romano, Caterina Patti, Corrado Schiavotto, Roberto Sorasio, Vincenzo Marasco, Laura Lissandrini, Davide Rapezzi, Daniela Gottardi, Federica Cocito, Antonino Mulè, Guido Gini, Roberta Zanotti, Alessandro Rambaldi, Vincenzo Bagnardi, Corrado Tarella
Journal: HemaSphere (2022)

Figure 1: According to response to FT, patients with late relapse vs early relapse vs refractory disease had 3-yr PFS of 77% (95%CI, 63–86) vs 82% i(95%CI, 66–91) vs 64% (95%CI, 54–73) Background: HDCT+ASCT is still considered the standard of care for patients (pt) with cHL failing first-line treatment(FT). However data on the efficacy of HDCT+ASCT in the era of PET-driven strategy are limited. Aim of study: To evaluate the outcome and prognostic factors of ASCT as first salvage treatment in pt failing or relapsing after FT. Methods: We performed a retrospective observational multicenter study on individual data of pt who underwent ASCT from 2009 to 2021 at 11 participating centers in Italy. Study endpoints were: clinical characteristics at relapse or failure, overall response rate (ORR) and complete remission (CR) to first salvage therapy (ST), number of ST before ASCT, disease-status at ASCT, 3-yr progression-free survival (PFS) and overall survival (OS) calculated from the date of ASCT, factors associated with ASCT outcome evaluated by univariate and multivariate analysis. Results: 217 evaluable pt were enrolled; 32% of them had a positive PET-2 (PET2+) after the firs 2 cycles of ABVD and 66% switched from ABVD to intensified therapy. Main pt characteristics at relapse or progression after FT were: median age 34 years (range, 18–68), stage III/IV 46%, B symptoms 25%, bulky 4%, extranodal disease 29%, anemia 13%, ECOG PS ≥2: 9%; refractory disease (failure to achieve CR with FT or relapse ≤3 months) 48%, early relapse (< 12 months from FT end) 24%, late relapse (≥12 months from FT end) 28%. Before ASCT, 53% pt received 1, 31% 2 and 16% received ≥3 ST lines. After first ST line, ORR was 65% and mCR 45%. Overall, 67% pt underwent ASCT in CR (98% of them in mCR), 22% in partial response (PR) and 11% with stable or progressive disease. After a median follow up of 42 months (IQR,24–66) 3-yr PFS and OS were 72 (95%CI, 65–77) and 90% (95% CI, 84–93), respectively. Figure 1 shows 3-yr PFS according to response to FT. According to disease status at ASCT and number of ST lines, 3-yr PFS was significantly better for pt in CR compared to their counterpart (HR 1.79, p=.039), and for pt receiving ≤ 2 vs > 2 lines ST (HR 2.52; p=.002). PET2+ during FT was associated with a higher risk of salvage ASCT failure (HR 2.43, p=.002). Conclusions: HDCT+ASCT is an effective salvage approach for pt failing a PET-guided FT, even for those with primary refractory disease. Receiving ≤2 ST lines and being in CR at ASCT confers the most favorable outcome, whereas a PET2+ in the FT seems an early unfavorable redictor for subsequent salvage ASCT procedures.